| NPI | 1740967249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANDRY KWIZERA Administrator 857-264-7049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2023-06-28 |